adopt, adapt, or abandon: an education plan built on process improvement
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Adopt, Adapt, Abandon:An Educational Plan Built on
Process Improvement
R. Gino Chisari, RN, DNPDirector of the
Norman Knight Nursing Center & Clinical and Professional Development
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Guiding Principles
• This was more than the “usual” process improvement strategy of the moment
• We would incorporate a known set of concepts and tools and apply them in a structured but flexible approach to designing a new reality
• All employees are included and encouraged to be part of the process
• Leadership support is mandatory
• New ideas to improve the work and for the team to learn together
The New Triple A
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
The Three Questions1. What are we trying to accomplish?2. What change might we try that could result in an
improvement?3. How will we know that a change is an improvement?
PDSA Cycle
Source: Langley et. al., The Improvement Guide
The Foundation – Plan, Do, Study, Act
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
After
Before
WASTE
Lean Targets Waste In a Process
Key: The Focus Is On the Process Not the People
VALUE
Value/Waste in Process
Source: GE Healthcare
The relentless pursuit of the perfect process through
elimination of waste & through respect for the worker
Lean – One Approach
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
• Define value from the patient’s perspective
• Identify the value stream – i.e. the patient’s experience from beginning to end
• Standardize work processes in order to identify & reduce unnecessary variation
• Establish and optimize flow
• Stop and correct defects, do not pass them along
• Continuously improve the process to perfection
Source: GE Healthcare
Lean Thinking – The Fundamentals
It’s About The Patient
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
• Test with willing volunteers
• Avoid the need for total consensus for testing
• Pick relatively easy, non-controversial changes first
• Collect useful data during the test and reflect on the results
• Be prepared to end the small test of change
• When the test is completed, select one of the following:
Adopt, Adapt or AbandonAdopt, Adapt or Abandon
Tips for Testing Changes
Adapted from IHI
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
The primary goals of the educational plan was to provide each participant with a:
• Strong base of support from which to successfully build upon, and actively engage on the Innovation Units
• Consistent understanding and application of the principles, concepts and other transportable components of the project’s aim across each of the innovation units
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Approach• Self-study assignments and Proficiency
Evaluation of Acquired Skills (PEAS) • Facilitated/Interprofessional Workshops • Unit-based modules• Attending Registered Nurse Weekly
Meetings
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Tracks• General – foundational, introductory
for all members of the community• Role – domain specific, including a
leadership track • Unit – team building/training
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Content Areas• Quality & Safety• Satisfaction: patients, families and staff• Clinical Outcomes• Best Practices• Diversity• Care Continuity• Financial Outcomes• Compliance Outcomes
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Ongoing and Continuous Development• Support the paradigm shift • Each member of the team is entitled to
professional development that raises the bar on excellence in patient and family centered care
• Designed on adult learner theory that actively engages the learner, resulting in a demonstrable change in behavior and performance
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
The Challenge and Opportunity• The need to continue providing
educational support to Phase I units, while simultaneously on-boarding Phase II and thinking about Phase III and beyond
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Topic: Resiliency TrainingTarget Audience: All members of the
Interdisciplinary TeamGoal: To provide the opportunity for all
members within the interdisciplinary team to develop skills necessary to successfully adapt to the quick pace of change
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Topic: Relationship Based CareTarget Audience: All members of the
Interdisciplinary TeamGoal: To provide a consistent and
uniform understanding of how each member of the interdisciplinary team has a unique opportunity to provide excellence through their personal contributions
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Topic: Conflict EngagementTarget Audience: Leadership Goal: To provide the necessary skills to
effectively engage with conflict and produce a positive and healthy outcome and environment
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Topic: Presentation SkillsTarget Audience: Attending RNGoal: To provide an opportunity for the
Attending RN to develop skill and confidence with their new and emerging role
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Topic: DiversityTarget Audience: All members of the
Interdisciplinary TeamGoal: To understand how the needs of
our patients, families and ourselves impact on our relationships
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Topic: HCAHPSTarget Audience: All members of the
Interdisciplinary TeamGoal: To provide a understanding and
meaning of patient satisfaction data and how every member of the team has a responsibility to “get the red out ”.
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Topic: Leadership CoachingTarget Audience: Innovation Unit
Leadership (nursing directors & CNSs)Goal: To provide a dedicated support to
the unit-based leadership in managing the complex nature of change at the local level
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Evaluation • Restate the goal• Assess for communication & marketing• Assess for availability and scheduling• Assess the adequacy of the content • Assess for personal goal attainment• Assess for an example of how the
information has been used• Comment section
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
Design• Electronic survey focusing on
communication and marketing strategies, availability and scheduling of educational activities, content and attainment of the desired outcomes of each activity
• Likert-type scale and free text responses that will be used to establish themes. The themes will drive further professional development and on-going educational interventions
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INSPIRATION | INNOVATION | TRANSFORMATION
THE NORMAN KNIGHT NURSING CENTER FOR CLINICAL & PROFESSIONAL DEVELOPMENT
“People grow through experience if they meet life honestly and courageously.
This is how character is built.”
Eleanor Roosevelt